MEDICARE: RAUL A. TREVINO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4162-T	TX

General Provider Information

NPI Number	:	1073650883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAUL A. TREVINO O.D.

Provider Business Mailing Address
First Line	:	2210 NW MILITARY HWY.
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1890
Country	:	US
Telephone Number	:	210-344-1400
Fax Number	:	210-342-2039

Provider Business Practice Location Address
First Line	:	2210 NW MILITARY HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1815
Country	:	US
Telephone Number	:	210-344-1400
Fax Number	:	210-342-2039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	05/08/2019

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